Combined effect of Controlling Nutritional Status and Acute Kidney Injury on severe COVID-19 short-term outcomes

Introduction/ObjectivesAcute kidney injury (AKI) and malnutrition are two complications commonly reported in severe forms of COVID-19, their combined effect on short-term mortality is, however, not yet investigated. The objective of this study is to determine both their individual and combined effects on short-term prognosis.Materials and methodsThis is a prospective, uni-centric study, including 247 severe COVID-19 patients, admitted between April 25th and June 20th, 2020, at the University Hospital of Blida. AKI was defined according to the KDIGO-2012 guidelines. Nutritional status was assessed using the Controlling Nutritional Status (CONUT) score. The association with in-hospital mortality was assessed using the Kaplan-Meier method and proportional Cox regression.ResultsAmong the 247 severely affected COVID-19 patients included in this study, 34.4% developed AKI, 30.4 and 1.2%, respectively, had moderate and severe CONUT scores, 17.7% worsened and progressed to a critical state and 26.7% did not survive. Both AKI and CONUT score were significantly associated with mortality in a dose-response manner (pLog-Rank < 0.0001). Their relative risks are respectively (HR = 3.25 CI 95% [1.99–5.3] and HR = 2.42 CI 95% [1.5–3.9], p < 0.0001). In multivariate analysis, the highest risk was observed for the AKI-CONUT-high combination (HR = 3.0, 95% CI [1.5–6.1], p = 0.002).ConclusionA possible synergistic interaction between AKI and CONUT score for COVID-19 short-term mortality has been highlighted. Monitoring of renal function associated with assessment of nutritional status should be performed routinely and systematically from the early stages of admission.     

The prevalence of serological markers for the human immunodeficiency virus and the hepatitis B virus in a psychiatric hospital

OBJECTIVES: To estimate the prevalence of antibodies to human immunodeficiency virus (HIV), antibodies to hepatitis B core antigen (anti-HBc), hepatitis B surface antigen (HBsAg), and antibodies to delta virus (anti-DV). DESIGN: Cross-sectional (prevalence) study. A non-proportional (stratified by length of stay) random sample of 20% of admitted patients was selected. CLINICAL SETTING: The Hospital Psiquiátrico Nuestra Se?ora de Montserrat (Sant Boi de Llobregat, Barcelona, Spain) admits about 670 patients in its short-term, rehabilitation (mid-term) and long-term wards. SUBJECTS: 139 patients were selected: 91% were males, mean age was 55 years, and 10% belonged to an HIV risk group; mean length of hospitalization since last discharge was 13 years. MEASUREMENTS: Blood samples were drawn in October, 1988. Anti-HBc, HBsAg and anti-DV were determined by competitive enzyme immunoassay (EIA). Anti-HIV-1 were determined by sandwich EIA; negativity of results with high absorbency but below the cut-off point was confirmed by Western blot. RESULTS: None of the sampled patients had circulating anti-HIV-1 antibodies. Four cases showing high absorbency (below the "cut-off" point) were ruled out by Western-blot. Overall, the prevalence of anti-HBc was 52.8% (54.4% in long-term wards, 35.0% in mid-term wards, and 13.8% in short-term wards). The prevalence of HBsAg was 2.3%, of anti-DV 1.5%, and of HDAg 0%. CONCLUSIONS: Prevalence of anti-HIV is null in the studied institution. Current efforts to prevent HIV infection must continue; a hepatitis B vaccination program is highly warranted among patients and professionals of the studied hospital.     

An association between sputum eosinophilia and carcinoma of the lung: a study of 549 patients

A prospective 11 year study of sputum cytology in 5,475 patients with respiratory diseases other than asthma or Loeffler’s syndrome showed that carcinoma of the lung was the commonest single condition associated with a sputum eosinophilia: it occurred in 68 (12.4%) of the 549 patients with pulmonary carcinoma. While clearly not a diagnostic finding, sputum eosinophilia should stimulate, in appropriate cases, a further search for carcinoma. The cause or causes of the eosinophilia are not known at present but the body’s reaction to malignancy is a topical subject of study worldwide.     

Research note: does cost recovery for curative care affect preventive care utilization?

Findings are presented from cost recovery pilot tests implemented by the government of Niger, with technical assistance from USAID's Health Financing and Sustainability (HFS) Project, in the primary health care sector in Boboye and Say districts during 1993-94. The tests focused upon the use of free prenatal care for pregnant women. Two different payment methods were tested along with interventions to improve the quality of care. An annual adult tax plus a small fee-per-episode at the time of use were assessed in Boboye, while a straight fee-per-episode of illness was implemented in Say. The difference in the financial burden to the consumer between the two schemes depended upon the number of illnesses experienced. Preventive services remained free of charge in all public facilities. Together with the introduction of cost recovery, health facility staff in the two test districts were trained on diagnostic and treatment protocols, an initial stock of generic drugs was provided to the involved health facilities, and a drug inventory and financial management system were established. Far from suffering with the introduction of cost recovery and quality improvements, the use of preventive services actually increased. Additional research is needed on the effect of cost recovery upon the use of preventive services.     

Sleep disorders in Tourette syndrome: a primary or unrelated problem?

Sleep disturbances are a common complaint in children with either Tourette syndrome (TS) or attention-deficit hyperactivity disorder (ADHD). Because a significant number of individuals with TS also have ADHD, we attempted to determine whether sleep difficulties reported in TS are a primary problem or are related to the co-occurrence of ADHD. Using a parent-completed sleep questionnaire, data were collected on boys, ages 7-14 years. Three groups, TS-only (N = 57), ADHD-only (N = 21), and TS+ADHD (N = 89), were compared to an age-matched control population (N = 146). The complaint of "poor sleep" occurred in 26% with TS-only, 48% with ADHD-only, and 41% with TS+ADHD; all were significantly different from 10% found in controls. Of 19 sleep questionnaire items, the incidence of problems occurred statistically more frequently in 5 of 19 for the TS-only group, in 6 of 19 for the ADHD-only group, and in 17 of 19 for the TS+ADHD group. Boys with TS+ADHD had many sleep problems which appeared to be related to an arousal disorder. Although the use of medications, especially stimulants and anti-depressants, were different between the TS-only and TS+ADHD groups, this factor did not account for the large discrepancies in sleep disturbance. In boys with TS, sleep problems usually occurred with the co-morbid feature ADHD.     

An association of pleuropulmonary blastoma and cystic nephroma: possible genetic association.

The association of pleuropulmonary blastoma and cystic nephroma is an uncommon entity, with only 4 cases of such an association in the same patient described in English literature. We report a 5th histologically documented case in a 32-month-old boy. The boy underwent a pulmonary biopsy that showed a pleuropulmonary blastoma and a nephrectomy that showed a cystic nephroma. The pleuropulmonary mass showed an important regression with postbiopsy chemotherapy, allowing subsequent tumorectomy. To date very little is known about this rare entity, and a genetic link between these 2 tumors is hypothesized.